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Archived: Eden Medical Group Good

Inspection Summary


Overall summary & rating

Good

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eden Medical Group on 24 and 30 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • The practice had made improvements to make it easier for patients to get through to the practice by phone and make an appointment. Urgent appointments were available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

  • The practice had implemented strong arrangements for managing the performance of staff. We saw all staff had a folder which included their core objectives, personal development plan and all the standards associated with their role. This helped to ensure staff were aware of what was expected of them and had ready access to guidance related to the tasks and duties they were responsible for. The approach focused on skills identification to ensure the practice had the right staff in place with the right skills. This helped ensure a sustainable future for the practice.

The areas where the provider should improvement are:

  • Assess and review the arrangements in place for the practice to meet the needs of patients with hearing impairment; to ensure they have good access to the practice and its services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 February 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. The practice had encouraged all staff to participate in this process by clearly setting out responsibilities in objectives as part of staff performance and development plans.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there are unintended or unexpected safety incidents, people received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.
  • Good medicines management systems and processes were in place.
  • The premises were clean and hygienic and there were good infection control processes in place.
  • There were appropriate arrangements for recruiting and vetting staff.

Effective

Good

Updated 4 February 2016

The practice is rated as good for providing effective services.

  • Data showed most patient outcomes were in line with the average for the locality. There were some areas where the practice was performing lower than comparators. They had plans in place as to how they would address areas of lower performance.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff. The practice had introduced a new performance development process, and we saw this supported staff to improve and understand their roles and responsibilities.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 4 February 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice in line with others for most aspects of care. The practice had plans in place as to how they would address areas of lower performance.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 4 February 2016

The practice is rated as good for providing responsive services.

  • They reviewed the needs of their local population and engaged with the NHS England Area Team and clinical commissioning group to secure improvements to services where these were identified.
  • Patients said they found it easy to make an appointment, with urgent appointments available the same day. The practice had implemented improvements within the last year to address problems with access to the practice by phone and making appointments. The practice was evaluating these changes to make sure they had realised the necessary improvements.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice did not have a hearing loop and this could impact on the ability of patients with hearing impairment to have full access to the service.
  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 4 February 2016

The practice is rated as good for being well-led.

  • They had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents.
  • We found the practice considered staff an asset to be invested in and nurtured.
  • The practice proactively sought feedback from staff and patients, which they acted on.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 4 February 2016

The practice is rated as good for the care of people with long-term conditions.

  • Effective systems were in place which helped ensure patients with long-term conditions received an appropriate service which met their needs. These patients all had a named GP and received an annual review to check that their needs were being met. For those people with the most complex needs, the named GP worked with other relevant health and care professionals to deliver a multidisciplinary package of care.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, the percentage of patients aged 8 or over on the asthma register, with measures of variability or reversibility recorded between 3 months before or any time after diagnosis was 90.1%, which was higher than the local average of 89.2% and the national average of 88.4%. The practice had plans in place as to how they would address areas of lower performance.
  • Longer appointments and home visits were available when needed.
  • Patients at risk of hospital admission were identified as a priority, and steps were taken to manage their needs.
  • Staff had completed the training they needed to provide patients with safe care.

Families, children and young people

Good

Updated 4 February 2016

The practice is rated as good for the care of families, children and young people.

  • Regular weekly baby clinics were held by practice staff. The GP partners provided support to the baby clinics. We saw good examples of joint working with midwives, health visitors and school nurses.
  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Childhood immunisation rates for the vaccinations given were comparable to clinical commissioning group (CCG) and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 84.6% to 96.0% and five year olds from 71% to 98.1%. The majority were around the same as the local CCG averages. The average percentage across the CCG for vaccinations given to under two year olds ranged from 83.3% to 96.0% and five year olds from 72.5% to 97.9%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. We saw there were information boards in the practice waiting area aimed at the needs of children and young people.
  • Where appropriate, younger patients were able to access contraceptive and sexual health services, and appointments were available outside of school hours.
  • Nationally reported data showed the practice had performed in line with average for providing recommended care and treatment for this group of patients.

Older people

Good

Updated 4 February 2016

The practice is rated as good for the care of older people.

  • Staff provided proactive, personalised care which met the needs of older patients. Patients aged 75 and over had been allocated a named GP to help ensure their needs were met.
  • Good arrangements had been made to meet the needs of ‘end of life’ patients. Staff held regular palliative care meetings with other healthcare professionals to review the needs of these patients and ensure they were met.
  • The practice offered home visits and longer appointment times where these were needed by older patients.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. 80.6% of patients aged 65 years or over received a seasonal influenza vaccination which was better than the national average (of 73.2%).

Working age people (including those recently retired and students)

Good

Updated 4 February 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice had assessed the needs of this group of patients and developed their services to help ensure they received a service which was accessible, flexible and provided continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • Nationally reported data showed the practice the practice provided recommended care and treatment that was in line with national averages for this group of patients. For example, bowel cancer screening rates within 30 months, for patients aged 60-69 was 60.8%, which was slightly lower than the national average of 63.9%.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Nationally reported data showed the practice had performed higher than comparators in providing recommended care and treatment to patients with mental health needs. For example, the practice achieved 100% of the points available in this area. This compared to an average performance of 95.4% across the clinical commissioning group (CCG) and 92.8% national average. 96.1% of patients with schizophrenia, bipolar affective disorder and other psychosis had a comprehensive agreed care plan documented within the preceding 12 months. This compared to a national average of 88.4%.
  • 84% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (compared to a national average of 84%).
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • They had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 4 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including patients with learning disabilities.
  • Staff carried out annual health checks for patients who had a learning disability and offered longer appointments.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Staff provided vulnerable patients with information about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff understood their responsibilities regarding information sharing, the documentation of safeguarding concerns and contacting relevant agencies.